Quilting Adventures, LLC
Seminar Registration Form

Please read the Registration Information page before completing this registration form.
It provides important details regarding our quilt seminar registration procedures and policies.
Registration is by MAIL or FAX only. Please allow 3 to 4 weeks for your confirmation notice.

Please complete this form online using the convenient data entry features.
Note: If the form doesn't work properly, please print the blank registration form and fill it in by printing clearly.

Participant Contact Information
Name:
Address:
City:
State:
Zipcode:
Country:
Telephone:
 (Day)    (Night)
FAX:
 Day Night
Email:
Roommate:
NP Spouse:
(Name of Registering Non-Participating Spouse)
Check if desired : Sewing Machine Rental Private Room (add $310)
Disability, please explain:
Allergies and/or Food Restrictions:

Seminar Selections
Please reserve my seat in: (Check all that apply.)
Seminar 1: March 7 - 12, 2010
Seminar 2: March 14 - 19, 2010
Seminar 3: March 21 - 26, 2010
Please indicate your 1st, 2nd, and 3rd instructor choice for each seminar you plan to attend.
Seminar 1 - Click the down arrow on the menus below to specify your 1st, 2nd and 3rd choices.
1st choice:
2nd choice:
3rd choice:
Seminar 2 - Click the down arrow on the menus below to specify your 1st, 2nd and 3rd choices.
1st choice:
2nd choice:
3rd choice:
Seminar 3 - Click the down arrow on the menus below to specify your 1st, 2nd and 3rd choices.
1st choice:
2nd choice:
3rd choice:

Liability Disclaimer
Quilting Adventures, LLC will not be responsible for any injury, loss or damage sustained by our students. By registering for the seminar, you agree not to make any claim against Quilting Adventures, LLC, its employees, volunteers or contractors.
 
Payment Information
I have enclosed :
Payment in full
Deposit
Payment Amount:
Payment type:
( check #):
Credit Card information: (For payment by MasterCard and Visa, please provide the following information.)
Note: the contents of this form are not submitted anywhere, so it is safe to type your credit card information here. This will make it easier for us to read the card information. However, if you don't feel comfortable typing in your credit card information, feel free to complete this section (with very neat printing) after printing the completed form.
Credit Card #:
Name on Card:
Exp. Date:
CVV#:
(code on back of card)
Your Signature:
_____________________________________________________

Emergency Contact Information
Name of Emergency Contact:
Telephone of Emergency Contact: (Day)    (Night)


Note: Click this reset button to clear the form when you are finished printing, or to start over with a blank form.

When you have completed the form above, print it (using File - Print in your browser). Then provide any necessary hand-written details, including signature and initials and either mail or fax the form with your payment to Quilting Adventures, LLC. as described in the instructions at the top of this page. (There is no need to fax or mail portions of this page below the line above. )

Thank you for choosing Quilting Adventures. We look forward to giving you a
"Taste of Texas...Hill Country Style"

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